A 45-year-old man comes to the physician because of a 3-week history of diarrhea and a 2.2-kg (5-lb) weight loss. During the past week, he has had six small bloody stools daily. He has HIV, gastroesophageal reflux disease, and hypertension. Current medications include chlorthalidone, omeprazole, emtricitabine, tenofovir, and efavirenz. He reports taking efavirenz irregularly. He is employed as a sales manager and regularly flies to South America. He is 175 cm (5 ft 9 in) tall and weighs 64 kg (143 lb); BMI is 22 kg/m2. His temperature is 38.1°C (100.6°F), pulse is 91/min, and blood pressure is 116/69 mm Hg. The abdomen is scaphoid. Bowel sounds are normal. His leukocyte count is 6000/mm3, erythrocyte sedimentation rate is 12 mm/h, and CD4+ T-lymphocyte count is 44/mm3. Colonoscopy shows areas of inflammation scattered throughout the colon with friability, granularity, and shallow linear ulcerations. The intervening mucosa between areas of inflammation appears normal. Biopsy from the ulcers reveals inflammatory infiltrate, mucosal necrosis, and enlarged endothelial cells with large, ovoid nuclei containing prominent basophilic deposits. Which of the following is the most likely cause of this patient's gastrointestinal symptoms?

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Quizplus · Accepted Answer

Eductional Objective: Cytomegalovirus (CMV) is a common cause of colitis in patients with advanced AIDS.  It is the second most common CMV reactivation disease in this population (CMV retinitis is the most common).  Patients with CMV colitis often have abdominal pain, fever, diarrhea, and weight loss.  Colonoscopy usually shows erythema, erosions, and ulcerations; colonic biopsy typically reveals large cells with prominent basophilic intranuclear inclusions.

A 45-Year-Old Man Comes to the Physician Because of a 3-Week